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Clinical Cases in mineral and bone metabolism

Study on changes in bone metabolism in a cohort of HIV-infected pregnant women and
their uninfected children

Case report, 88 - 91
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Osteopenia and osteoporosis are frequent in HIV-infected patients, because of disease itself and therapy. This study evaluated the incidence of bone disorders in 18 infected pregnant women treated with antiretroviral drugs and in their uninfected children.
Biochemical markers of bone metabolism were obtained every three months in pregnant women and at 1, 6 and 12 month of age in children. Serum levels of calcium, inorganic phosphate, bone specific alkaline phosphatase were collected; moreover serum levels of osteocalcin and urinary CTX concentrations were evaluated as bone synthesis and bone resorption index respectively. Ultrasonographic bone densitometry was performed in women once in pregnancy and in children at 1, 6, 12 months of age. In order to critically analyze these data, a normal line was generated from data obtained from a cohort of 80 italian children aged 0-12 months: this is the first study ever performed on newborns and infants, in the aim to identify the normal values of reference in this cluster of age.
Lower bone density values, compared with control subjects, were detected in 7/18 women (38.8%): osteopenia was found in 3 women and osteoporosis in 4. Normal serum levels of osteocalcin were detected in osteopenic patients while the serum concentrations were low (< 2.5 ng/ml) all over pregnancy in the four cases of osteoporosis. High CTX urinary concentration was observed in 3 cases of osteoporosis.
In just 2 children (born to women who had started an antiretroviral therapy with PIs before conception and have been treated for more than 30 months) low bone density was diagnosed by ultrasonographic densitometry at the first month, but it was found normal both at 6 and 12 months of age. Only in these two cases high CTX urinary concentration was observed at the first month, and was found normal at the following evaluations.
The pathogenesis of low bone density observed in pregnant women is multifactorial, involving HIV- and HAART- related factors. Bone metabolism resulted normal in most children perhaps because of the lack of HIV infection.

Vol. XV (No. 2) 2018 May - August

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